European Child & Adolescent Psychiatry最新文献

Previous longitudinal studies have explored the developmental mechanisms of non-suicidal self-injury (NSSI) and suicidal ideation (SI) in adolescents and primarily focused on variable levels rather than trajectories (e.g., intercepts and slopes). The present study aimed to explore the developmental trajectories of NSSI and SI among Chinese adolescents, emphasizing the predictive roles of fear of negative evaluations (FNE) and thwarted belongingness (TB) on these trajectories from an interpersonal perspective. The latent growth model was incorporated to construct a mediation model of FNE, TB, NSSI, and SI. A total of 515 adolescents (M_age = 12.309, SD = 0.807; 49.3% girls) completed questionnaires on 4 waves, 6 months apart. The results showed that: (1) FNE showed a curvilinear growth trajectory, with a progressively smaller growth rate; TB, NSSI, and SI all showed a linearly decreasing trajectory; (2) in the relationship between FNE and NSSI, TB's intercept mediated the relationship from FNE's intercept to NSSI's; (3) in the relationship between FNE and SI, TB's intercept mediated the relationship from FNE's intercept to SI's intercept, as well as to SI's slope. Meanwhile, TB's slope mediated the relationship from FNE's slope to SI's. This study reveals the dynamic developmental trajectories of FNE, TB, NSSI, and SI in Chinese adolescents. Notably, TB plays a different mediating role between FNE, NSSI, and SI, highlighting its critical role in the development of these behaviors. Early interventions targeting FNE and enhanced belongingness may help prevent or reduce NSSI and SI in adolescents.

Little research has examined early life risk for symptoms of cognitive disengagement syndrome (CDS) despite a well-established literature regarding co-occurring outcomes (e.g., attention-deficit/hyperactivity disorder). The current study estimated bivariate associations between early life risk factors and CDS in a large and representative sample of U.S. children. We conducted secondary analyses of baseline data from the Adolescent Brain Cognitive Development (ABCD) study (N = 8,096 children, 9-10 years old). Birthing parents reported early life risk factors on a developmental history questionnaire, including parental, prenatal, delivery and birth, and developmental milestone information. They also completed the Child Behavior Checklist, which includes a CDS subscale that was dichotomized to estimate the odds of elevated CDS symptoms (i.e., T-score > 70) in children related to risk indices. We observed significantly elevated odds of CDS related to parental risk factors (i.e., unplanned pregnancy, pregnancy awareness after 6 weeks, teenage parenthood), birthing parent illnesses in pregnancy (i.e., severe nausea, proteinuria, pre-eclampsia/toxemia, severe anemia, urinary tract infection), pregnancy complications (i.e., bleeding), prenatal substance exposures (i.e., prescription medication, tobacco, illicit drugs), delivery and birth risk factors (i.e., child blue at delivery, child not breathing, jaundice, incubation after delivery), and late motor and speech milestones in children. Several early-life risk factors were associated with elevated odds of CDS at ages 9-10 years; study design prevents the determination of causality. Further investigation is warranted regarding early life origins of CDS with priority given to risk indices that have upstream commonalities (i.e., that restrict fetal growth, nutrients, and oxygen).

This study explores the roles of the precuneus and posterior cingulate cortex (pCunPCC) in the relationship between premonitory urge (PU) and tic severity in Tourette syndrome (TS). We recruited 58 children diagnosed with TS (age mean ± SD = 11.12 ± 2.56, F/M = 11/47). Tic and PU severity were measured using the Yale Global Tic Severity Scale (YGTSS) and the Premonitory Urge for Tics Scale (PUTS), respectively. We constructed brain functional networks for each subject based on resting-state fMRI and further calculated the degree centrality (DC), global efficiency (GE), and local efficiency (LE) of each pCunPCC region. A significant positive correlation was found between PUTS and YGTSS scores (t = 4.75, p < 0.001). The DC and GE of the right pCunPCC ROI 3 (Schaefer Atlas) showed significant negative correlations with YGTSS (t = -2.63, FDR-corrected p = 0.03 for DC; t = -2.85, FDR-corrected p = 0.04 for GE) and PUTS scores (t = -3.35, FDR-corrected p = 0.01 for DC; t = -2.95, FDR-corrected p = 0.03 for GE). Moderation analysis indicated that higher DC in the right pCunPCC ROI 3 reduced the effect of PU on tic severity. These moderation effects were also observed with PU and vocal tics, but not motor tics. The right pCunPCC serves as critical moderator in the relationship between PU and tic severity. This study highlighted the potential neural mechanisms underlying the relationship between PU and tic severity, providing potential targets for future intervention and treatment of TS.

Do the shortened Positive and Negative Syndrome Scale (PANSS) (Kay et al., J Clin Psychiatry 58:538-546, 1987) versions recently developed from a National Institute of Mental Health (NIMH) pediatric dataset continue to perform well in a third independent randomized double-blind clinical trial of adolescents with schizophrenia? Secondary analysis of the double-blind, placebo-controlled aripiprazole pivotal trial data (N = 302) found that the 10-item (and 20-item) PANSS versions on which we have previously reported (Findling et al., J Am Acad Child Adolesc Psychiatry, https://doi.org/10.1016/j.jaac.2022.07.864 , 2023) continued to provide high reliability, strong convergent correlation with expected measures, and treatment effects that equaled those found in the 30-item adult PANSS. Our shortened PANSS, derived originally from the randomized non-placebo controlled NIMH Treatment of Early Onset Schizophrenia Spectrum study (TEOSS) (Sikich et al., Am J Psychiatry 165(11):1420-1431, 2008), and independently replicated in both the placebo-controlled paliperidone pivotal trial for adolescents with schizophrenia (Youngstrom et al., PsyArxiv, https://doi.org/10.31234/osf.io/zb695 , 2023), and now the placebo-controlled aripiprazole pivotal trial for adolescents with schizophrenia, has again performed as well as the full 30 item adult-patient derived PANSS. The findings suggest it is possible to reduce the PANSS interview by 2 thirds, thus reducing burden on families and pediatric patients as well as administration and training costs, while maintaining high reliability, validity, and sensitivity to treatment equal to that of the 30-item version.

Mental health problems are common in children and young people (CYP) in England, yet evidence suggests high levels of unmet need. Understanding of the determinants of mental health-related service contact is needed to identify gaps in provision and areas for targeted intervention to improve access. A secondary analysis of the Mental Health of Children and Young People in England 2017 (MHCYP-2017) cross-sectional survey dataset was performed. This analysis describes mental health-related support and service contact amongst a national stratified probability sample of 6681 participants aged 5-16. A range of socio-demographic and clinical characteristics were analysed as explanatory variables and their relationships with different types of support and service contact were examined through multivariable multinomial logistic regression. Analyses were stratified by age group: 5-10- and 11-16-year-olds. Analyses revealed strong associations between participant socio-demographic/clinical characteristics and mental health-related support and service contact, independent of CYP mental health status and parental perception of difficulties. Among these associations, socio-economically disadvantaged and Black, Asian and Minority Ethnic CYP were less likely to have had professional contact for mental health problems in both age groups. Findings suggest there may be higher levels of unmet need in socio-economically disadvantaged and Black, Asian and Minority Ethnic CYP, warranting further investigation and efforts to address inequalities.

Adolescent sexual violence is a serious public health concern that may have lasting impacts on the survivor, yet limited longitudinal research on the behavioural and mental health outcomes following sexual victimization exists. To describe the long-term behavioural and mental health outcomes associated with sexual victimization at 14 years of age, and whether these outcomes differed by sex, sexual orientation, and ethnic minority status. This prospective study used data from the Millennium Cohort Study, a nationally representative, longitudinal cohort study of children born in the United Kingdom between 2000 and 2002. Sexual victimization was self-reported when cohort members were 14 years of age, and outcomes (self-harm, suicide attempt, distress, alcohol use, binge drinking, smoking, vaping, and illicit substance consumption) were measured at age 17. Sexual victimization at age 14 was associated with poorer mental health, binge drinking, smoking regularly, vaping, and illicit drug use at age 17. Mental health outcomes differed by sex and these associations were stronger for males than females (self-harm: males RR = 2.4,95%CI: 1.55-3.79, females RR = 1.3,95%CI: 1.10-1.63; distress: males RR = 3.3,95%CI: 1.73-6.24, females RR = 1.4,95%CI: 1.08-1.75). Compared to non-victimized heterosexual adolescents, victimized heterosexual adolescents had nearly twice the risk of self-harm (RR = 1.87,95%CI: 1.40-2.46) and distress (RR = 2.09,95%CI: 1.46-2.96). Victimized adolescents belonging to an ethnic minority group showed three times the risk of distress (RR = 3.35,95%CI: 1.70-6.61) and non-ethnic minorities were more likely to vape (RR = 1.56, 95%CI:1.08-2.25). Adolescents who experience sexual victimization are at increased risk of poorer mental health later in adolescence.

Previous studies have shown an association between depression and increased susceptibility to infection in the general population. However, there has been no prior research specifically examining the relationship between treatment-resistant depression (TRD) and severe bacterial infections (SBI) in adolescents and young adults. This retrospective observational cohort study utilized the Taiwan National Health Insurance Research Database (NHIRD) from 2001 to 2010. It included adolescents (12-19 years of age) and young adults (20-29 years of age) diagnosed with major depressive disorder (MDD), comprising 6958 cases of TRD and 27,832 cases of antidepressant-responsive depression (ARPD). The TRD and ARPD groups were further matched (4:1) by chronological age, age at diagnosis of depression, sex, residence, and family income. The primary outcomes were severe bacterial infections (SBI) and septicemia. Cox regression analysis was conducted to identify the risk of hospitalization due to SBI or septicemia during the follow-up period. Compared with controls, the ARPD group had increased risks of SBI (hazard ratio [HR] with 95% confidence interval [CI]: 3.90, 2.73-5.57) and septicemia (HR, 95% CI: 2.56, 1.34-4.91). Notably, the risks of SBI and septicemia appeared to be further elevated in the TRD group. The TRD group exhibited higher incidences of SBI (HR, 95% CI: 6.99, 4.73-10.34) and septicemia (HR, 95% CI: 2.85, 1.28-6.36) than the control group. Adolescents and young adults with TRD had 6.99-fold and 3.90-fold increased risks of SBI and septicemia compared to individuals without MDD, respectively. Therefore, healthcare providers need to be vigilant when monitoring and implementing preventive measures in this population.

Pediatric major depressive disorder (MDD) often leads to recurrent depression in adulthood. The efficacy, safety and dose dependency of pharmacological effect is unclear. We conducted a systematic review and dose-response meta-analysis comprising of 22 double-blind randomized controlled trials, the majority of which had short trial durations ranging from 6 to 12 weeks. Studies were identified from PubMed, Ovid Embase, Ovid Medline, Ovid PsycInfo, Wanfang, ClinicalTrial.gov and CENTRAL until July 31, 2023. Doses of all antidepressants were converted to fluoxetine equivalents. Outcomes including treatment response, remission, suicidality, tolerability and acceptability were assessed. Sensitivity analysis, funnel plot and the trim-and fill method are used to assess and adjust for publication bias. Findings revealed that antidepressants were marginally more effective than placebos in terms of treatment response, but significantly increased the risk of adverse effects. No significant differences were observed in remission, suicidality, or overall dropout rates. Dose-response analysis indicated a relatively flat increase in response probability with higher fluoxetine equivalent doses, but also a sharp increase risk of discontinuation due to side effects. This study suggests that antidepressants for pediatric MDD may be less effective in adults, emphasizing the need to balance treatment benefits with potential adverse effects when considering interventions for this population.

This study aims to investigate the potential correlation between commonly prescribed attention-deficit/hyperactivity disorder (ADHD) medications and suicidal or self-injurious behaviors (SSIBs) among the pediatric population by exploring the FDA Adverse Event Reporting System (FAERS) database. The FAERS database (2004Q1-2023Q4) was queried and SSIBs cases associated with stimulants (methylphenidate, and amphetamine) or atomoxetine were identified. The signals for SSIBs were analyzed using disproportionate methods, and the accuracy of the results was validated through sensitivity analysis with multifactor logistic regression. Time-to-onset analysis explored factors affecting SSIBs manifestation. Disproportionality analysis revealed a significant negative association between methylphenidate and SSIBs, while atomoxetine exhibited a significant positive correlation with SSIBs. The frequency of SSIBs was lower with stimulants alone or with the combined use of stimulants and atomoxetine compared to atomoxetine alone. Time-to-onset analysis indicated that all cases were of the early failure type, with the median time to onset of SSIBs associated with atomoxetine occurring later than that linked to stimulants. Stratification by age showed that in the stimulant group, the median time to SSIBs was longer for patients aged 13-17 years compared to those aged 6-12 years. Conversely, the opposite trend was observed in the atomoxetine group. The observed differences in time to onset highlight the importance of individualized screening for SSIBs across various populations, ultimately improving patient outcomes in the follow-up of stimulants or atomoxetine recipients.

Emerging research suggests a positive association between Internet gaming disorder (IGD) and suicidal behaviors. However, existing studies predominantly focus on suicidal ideation rather than suicide attempts and often do not adequately control for potential psychological confounders. The mechanism linking IGD to suicidality remains unclear. This study aims to assess the independent association between IGD and suicidal behaviors and to examine the mediating role of sleep disturbance among Chinese adolescents. We recruited 135,174 middle school students from Zigong City using cluster sampling. Data on demographics, suicidal ideation, and suicidal attempts were collected. IGD was assessed using the Internet Gaming Disorder Scale-Short Form. Mental distress, including depression, anxiety, hyperactivity/inattention, conduct problems, sleep problems, and psychotic experiences, was evaluated using standardized questionnaires. Multiple logistic regression models and mediation analysis were conducted. The prevalence rates of IGD, suicidal behaviors, suicidal ideation, and suicide attempts were 1.6%, 16.7%, 11.9%, and 9.8%, respectively. Adolescents with IGD showed a significantly higher risk for suicidality: nearly 60% reported suicidal behaviors, 50% reported suicidal ideation, and 40% reported suicide attempts. Both IGD and gaming usage were independently linked to suicidal behaviors. Sleep disturbance partially mediated the relationship between IGD and suicidal behaviors, accounting for 47.0% of the total effect. Our studies call for timely and regular assessments for suicidality and sleep disturbance in IGD. Targeted interventions addressing sleep disturbance might reduce suicidal risk among adolescents with IGD.